Hospital VBA2C with a Curved Tailbone After Two FTP Cesareans at 10 Centimeters with Licia Popernack

Meet Licia Popernack

Licia Popernack: I was told after the surgery that I had a curved tailbone and that there's no way I could ever have a vaginal birth. So I felt like things were just stacked against me. When I was really looking for stories and listening to a lot of podcasts and reading a lot of blogs and reading books and talking to my doctors, it sounded like most of the time the stories that I came across that were about successful VBACs after two tended to have a cesarean because of a breech presentation or a failed induction or something else. Or maybe there was a previous vaginal birth, which upped their chances.

When I was pregnant this last time, no one ever said that they didn't think I should try for a VBAC after two cesareans, but sometimes it was implied like, I was offered a growth scan. "Oh, well, you know, your other babies were like seven pounds. Maybe let's get you in for a growth scan at like 36 weeks and see how big baby's looking."

And it was like, "huh, you know, it sounds like a good idea." And I could see a lot of women wanting, "oh sure, that sounds great. Let's do that." But I knew in the back of my mind that growth scans that late in pregnancy aren't really reliable measures of a baby's size. And I knew that if I went through with the scan, then, even though it's not accurate, then that's in the back of my mind.

"What if my baby's 10 pounds? What am I going to do?" So I think, women just really need to be on the lookout for things like that.

I think to anybody that's having a baby, whether you're choosing to have a repeat cesarean or you're a first time mom and you're having a cesarean, or you're deciding if you want to do a TOLAC or you want to do a VBAC after two or after multiple, it's just such a personal choice. That it's really an intimate decision that you need to make with your support person and yourself and think about your family.

There's not a one size fits all. There's not one thing that's right for everyone. What's right for me, wouldn't work for someone else. But I just want people to know that if you're like me, if you are going through a similar experience where you've had multiple cesareans for CPD or arrest to descend, that you could have the birth experience that you're looking for. You could have a successful VBAC and have a healthy child and just a great experience.

Jen Kamel: Hello. Hello. Welcome to The VBAC Facts® Podcast. I'm Jen Kamel, VBAC Facts® founder. And since 2007 our focus has been to provide accurate and objective information on vaginal birth after cesarean and repeat cesarean to parents, professionals, policymakers and the court so all decisions can be informed, ethical, and just.

And before I bring today's guest on, I want to ask you a quick favor. Would you please subscribe or follow this podcast? If you do this, I promise to continue to bring you evidence-based conversations on vaginal birth after cesarean including the sometimes shocking medical evidence, breathtaking birth stories, inspiring advocacy victories and sobering legal cases. And while you're there, leave us a five star rating and a quick review, even if it's just one sentence.

Why She Wanted to Share Her Story

Jen Kamel: Today we have with us Licia Popernack. Licia had a vaginal birth after two cesareans and I am so excited to share her story with you to show you what is possible.

Licia is the mother of four, three biological and one bonus. When Licia became pregnant with her first, she knew she wanted to have an unmedicated low, or no, intervention vaginal birth. Unfortunately, despite her best efforts, and isn't that the story with so many parents, she ended up with a C-section. Licia tried for a VBAC with her second, but again, ultimately her labor ended in another cesarean. Finally, with her third birth, she had a successful vaginal birth after two cesareans. Licia hopes that her story will bring awareness and hope to others in similar situations to hers. Welcome Licia, I'm so excited that you're here with us today.

Licia Popernack: Thank you so much, Jen. I'm honored to be here and to share my story. I love VBAC Facts® and I'm just so honored to be on the podcast today, and I hope that my story is able to reach a lot of women that are in similar situations to what I went through.

Jen Kamel: I'd like to start with that because there was something very specific that you wanted to share by sharing your story.

Licia Popernack: I was subscribed to your email list. So I would always read new articles and things that you were putting out. I think I reached out to you this past summer. I had my son at the end of May and I had sent you a picture, I don't know if you remember this, but I ended up sharing a photo of me and my son right after I had my VBAC after two.

And you and I had corresponded back and forth and you said something along the lines of that you could really see the joy, just the pure joy, in my face and how proud I was. I feel the same way. When I look at that picture.

It's funny because with my other children, my first picture, I'm laid out on a table and I have, you know, a shower cap on, and my makeup, my eye mascara is all over, and I just look really out of it.

I really don't look at any of those photos. With this picture, I have it printed out. I have it hung up in the nursery, and I look at it often. After some time I reached out again because I was hopeful that maybe we could do some sort of interview. Again, I'm just so thankful for this opportunity.

Jen Kamel: The thing that I recall about that interaction is how when you were trying to find birth stories of people who reached 10 centimeters and pushing and then had a C-section and who ultimately had a VBAC, you had a really hard time finding stories like that. I remember you saying how much you wanted to give other people hope by putting your story out there so more people could see, even if you reach 10 centimeters, and then had a C-section, VBAC is still an option.

Licia Popernack: Yeah, I think when I was really looking for stories and listening to a lot of podcasts and reading a lot of blogs and reading books and talking to my doctors, it sounded like most of the time the stories that I came across that were about successful VBACs after two tended to have a cesarean because of a breech presentation or a failed induction or something else. Or maybe there was a previous vaginal birth, which upped their chances.

And for me, I felt like, I don't know, maybe the cards were stacked against me. Like you're saying, I went into labor spontaneously. I ate all the dates, I drank all the tea, I was ready to go. I made it to 10 and then, push, push, push and just wasn't, you know, it was arrest to descend.

And then I was told, oh, I have CPD. I actually was asked if I had rickets as a child. I was told then my after the surgery that I had a curved tailbone and that there's no way I could ever have a vaginal birth. So I felt like things were just stacked against me.

What Her Doctor Said About Her VBAC Odds

Licia Popernack: When I was pregnant this last time, and I talked to a doctor, he was very nice, and he didn't try to discourage me, but I asked him, "you know, how optimistic are you about me trying for another VBAC?" And he said, "well, you know, we're happy to let you try. But in circumstances like this, history does have a tendency to repeat itself. So you just want to make sure you know that you have your head on straight. And you know, ultimately that it could end in a cesarean. But typically if people get to 10 and they push and then they get to 10 and they push again, and they're not descending, it's likely that that could happen again."

Her First Pregnancy

Jen Kamel: Okay, so we have kind of set up the whole story. I would love to go back in time a little bit and set up the scene a little bit. So can you

Licia Popernack: Okay.

Jen Kamel: about your first pregnancy? What did that look like, and how did you end up having that first C-section?

Licia Popernack: When I first became pregnant, it was almost immediate that I knew I wanted to have an unmedicated low intervention birth. I joined a prenatal center, which was really cool. I took yoga classes there. I took a birthing class, I took a breastfeeding course. I got to meet other first time moms. I got to meet moms that had already gone through the process, so I felt like I was ticking all the boxes. Okay. I'm staying healthy, I'm eating healthy, I'm doing all these things.

I read Ina May Gaskin. I just kind of had this dream scenario of what my birth would look like. So I enrolled in a hypnobirthing program. I did all the homework and I'm a teacher, so I was like, okay, prepare, do the homework and everything will just fall into place. Like I said, I ate the dates, I drank the tea. I was ready to go.

And I went into labor eight days early in the middle of the night. Then come the morning I was like, okay, I think we should go to the hospital. We went I hadn't had any cervical exams during my pregnancy, so when we got to the hospital and they checked me, I was only three centimeters, and in hindsight, I probably should have gone back home and come back later, like all the books say to do, but I just was so excited.

And they said, you know, oh, we hadn't checked your cervix before, so maybe you were zero and now you're three, so we're just gonna admit you. So I stayed and things were progressing slowly. My daughter was sunny side up and so I had some back labor, but I felt overall calm, maybe a little bit impatient, but calm. And I felt like the pain was manageable.

Biggest Regret: "But That Locked Her In..."

Licia Popernack: And then my biggest regret, my doctor checked me again and still wasn't making a ton of progress after a few hours. So she offered to break my water and I agreed.

And I know again, you read about the cascade of interventions and I knew it probably wasn't a good idea, but in the moment, you know... you think about when you're being rational and you're doing research and you're preparing, "oh, I, when I'm in this situation, I'm gonna do all the right things."

But then when you're actually there and a doctor in the white coat and they've been doing this for a very long time, and you're frustrated and you're impatient. And so you, sometimes agree to things that you think you wouldn't have agreed to before, and it, you know, oh, it's not that big of a deal. Okay, it'll get things moving.

But I think that since she was sunnyside up, having that cushion then removed, I don't know in hindsight, who knows, but maybe she would've been able to turn into a better position, but that kind of locked her in.

Pushed For Four Hours, Then Cesarean

Licia Popernack: Still slowly but surely progressed. And then when I made it to 10, I pushed and I pushed for over four hours. My husband was incredible, so he really, really was supportive.

Another thing that I think made me impatient or kind of got into my head was that both of our families were really excited and they came to the hospital pretty early in the labor process. And I didn't see anybody when I was in the birthing room, but I knew in the back of my mind, "everyone's in the waiting room."

And, you know, every hour or so, my husband would go out and update them even though there wasn't much of an update to give. And we tried everything. We tried the birthing ball, the peanut, they brought, you know, a, a bar down from the ceiling. It was like Cirque de Soleil. I am kind of like hanging around and really tried all of, all of the different things.

And my doctor started kind of hinting at, "well, I don't know if this is panning out. I'll let you push for a little while longer, but I don't know that that baby's gonna come on its own." And then over time, she started them pulling my husband aside and getting in his ear. And then finally he helped me to decide, okay, I think let's cut our losses. And it's time.

She, one thing I'll never forget, she said, "You pushed for four hours. You know, I could let you push for four more. But the baby's not gonna come out. And then you're just gonna be exhausted and things could go wrong right now, baby's fine, you're fine. But in the next minute, something could become a dire situation."

So I agreed I had the C-section. It was really not a great experience. I had a lot of trouble bonding with my daughter. I just felt really out of it. Yeah, just overall, I mean, there were no complications. She was fine. Her Apgar score was great. My recovery was okay. But I just really. I didn't get to hold her right away. And I don't know if that was part of it, but I had a hard time connecting with her.

Her Doctor Had An Early Flight

Licia Popernack: And the worst part was the next day when a doctor came to check on me to see how I was doing, I asked where my doctor was and they said, "oh, she had an early flight to China" and my hospital's policy at the time, I don't, I actually don't know if it's still their policy, but was that the doctor stayed on the floor until all of their patients delivered.

So I had been her last patient and she, you know, had a flight scheduled. It also doesn't help that the hospital cesarean rate is over 40%, when the rate in Pennsylvania is 31 ish. But that really stuck with me that, okay, maybe I could have done it if I had more time and she didn't have a plane to catch.

Postpartum: "I Felt Really Isolated"

Jen Kamel: "Yeah. So after that baby was born, were you thinking at all, like, did you want more children? Were you thinking what you wanted for that next pregnancy and labor, or was that not even on your mind?

Licia Popernack: I think after I had my daughter, I definitely had a little bit of postpartum depression, and I kind of went down a rabbit hole of reading other women's stories. And at first, I didn't feel my family was complete, but then I also had this guilt like, well, I'm not even really bonding with my child.

But maybe if I had had a different experience, I would feel differently. So I did start to think about, okay, if in the future I do have another child, I would want this like redemptive experience, some sort of healing process that I could do it. And so I did start to research kind of early on what it looks like to have a VBAC and how I could prepare.

So I knew one of the things was to wait, you know, between 18 to 24 months before trying to conceive again so that your uterus could heal. So I did wait and, um, yeah, I just, I don't know. I feel like a lot of people didn't really understand how I was feeling. Even though the cesarean rate is around 31%.

I felt like I was the only one in my friend group that had had a C-section out of like around 10 of us. I'm like, okay, well it seems like there's only 10% and it's me. Not that I had wished a cesarean on anybody else, and some people choose a cesarean on their own. And that's, it's, you know, there's a lot of different reasons people make choices surrounding their births. It's extremely personal.

But I just felt really isolated and I felt like a lot of my friends and family were meant well and my husband as well. But saying things like, "well, you know, you're okay. You're here. You're healing. Your daughter's beautiful. What do you have to be upset about?" And then that kind of made me feel more guilty, in a sense, because it was like the rational side is like, yeah, why? You know, why am I having this kind of like, pity party? But I felt like if I could move on that having a VBAC could help me to do that.

What Would Have Felt Supportive and Validating to Her

Jen Kamel: And so in those moments when friends and family were trying to be supportive but really weren't, what would've been helpful to hear, because I think that's something that people need a little bit of coaching on, and they need to hear like, well, if I can't say this, what's the right thing to say? So what would've felt supportive and validating to you?

Licia Popernack: It is a really hard thing 'cause you even, you know, myself, what might have been a, the right thing for me to hear, other women, it maybe wouldn't have been the right thing. I think honestly, less is more just hearing something like, "I'm here for you or do you want to talk about it? I, I'm here to listen."

I know, you know, saying things like, "Well, you're healthy" or "You have a healthy baby, everything's fine." You know, it's coming from a place of love, but it doesn't feel that way. So I think, yeah, just saying, "I'm here for you. How can I help you?"

And even my mom, I was born a c-section. My brother was also born a c-section. And my mom was like, "Oh, I was glad to have a C-section. I was so tired and you wouldn't come out. So I was happy to have one. And then I scheduled one with your brother."

And she had kind of a traumatic experience because then her scar opened and she had to like pack it. And she had some other complications, but even with that, she was like, "I don't understand why. You know, maybe you should just schedule it."

So even though she had gone through this, what I wanted wasn't ever something that she had wanted, or, and I guess in the eighties and nineties too, you know, VBACs were even less heard of than they are now.

So it just, it was funny because I thought that I would feel better talking to her, and I know that she only wants the best for me out of everyone. But she really couldn't relate. I felt like nobody could relate to how I was feeling.

Jen Kamel: Yeah. And that is such a lonely place to be, because I know for myself, of course, I was thankful that I had my C-section. I was thankful that my baby was healthy, but also I was very much mourning having a vaginal delivery and mourning what this meant for my future options. I think unless people have been there, or at least unless people have heard something like you sharing your story now, it might be hard for them to wrap their brain around those two conflicting emotions happening at the same time.

Licia Popernack: Yeah, totally Jen.

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What Was She Told About VBAC?

Jen Kamel: So you had your first C-section, you're there in the postpartum period, did any healthcare provider say to you, "oh, next time VBAC is an option," or, "oh, next time you can have a C-section?" Was there any discussion of what your future options were?

Licia Popernack: From being in the hospital room recovering, I don't recall if that was brought up that early, but I do know for sure at my first postpartum checkup at around six weeks, immediately it was, "well, let's get you back on birth control. Let's get you an implant." And I was like, "well you know, yeah, I don't want to have a baby right now, but I really don't want the implant."

And they really pushed for that and said, "you could get pregnant again and then it's really risky to have another C-section if you don't leave enough time between." So it was just kind of implied, like, "okay, well you're not even pregnant yet. You're not even thinking about having another baby, but when you do, you're gonna have a C-section. And if you don't leave enough time between, it could be risky."

So it just, yeah, VBAC didn't really come up and I feel like I was always the one to bring that up when I was pregnant again.

Her Second Pregnancy

Jen Kamel: And so when you did get pregnant again, how did that pregnancy and labor unfold?

Licia Popernack: So when I got pregnant again, I was hopeful to have what I dreamt of the first time around. I wanted that to come to fruition. So this time I did the hypnobirthing again. I did a VBAC specific hypnobirthing, and they had like a letting go of fear component that I tried. So I wanted to do all the right things.

I wanted to read all the books. So this time I read Silent Knife. I read VBAC Companion. Vaginal Birth after Cesarean. So I read a few books. I listened to a lot of podcasts. I tried to prepare.

Jen Kamel: Why was planning a VBAC important to you once you had one prior cesarean?

Licia Popernack: I think I just really wanted that redemptive experience. I wanted a healing experience. I wanted to show myself, my doctors, everyone that I could do it. I had just felt, again, so robbed the first time around. And I know that cesarean can be lifesaving interventions, and I'm so thankful that they exist in the scenarios that they're needed.

I just felt like I didn't need one, that if I had had more time, maybe things could have panned out. So I really wanted just what I missed out on. I wanted to hold my baby right after they were born. I wanted that golden hour. I wanted to nurse them right away and feel that connection.

Changed Providers at 34 Weeks!

Jen Kamel: And so when you got pregnant again, did you stay with that original provider or did you find another provider?

Licia Popernack: So initially I stayed with the same provider. I know we spoke about this, that I ended up changing hospitals at 34 weeks. When I was pregnant with my son, it was the height of COVID. One of the things on my list with the books that I read and the things that I was doing to prepare was hiring a doula.

That was a common thread of things that you could do to have maybe a more successful chance at having a VBAC. So I hired a doula pretty much right away. I was really open with my providers that I wanted a doula there. I also wanted my husband there, and it was really an uncertain time, right?

So there were mask mandates and then they were limiting the number of people in the room so there were a lot of moving parts and I don't really fault anyone for that because nobody knew what was going on and their job as a hospital is to keep everyone safe.

But I felt like it just was kind of unclear because I would be at an appointment and they would say, "well, right now we're only limiting one support person with the birthing mother, but you still have some time. Things are changing. We don't think it's gonna be an issue that you have a doula."

So I felt like I kind of was being strung along, whether purposely or not. Then, once I'm past 30 weeks, I'm like, "okay, well I kind of need to know for sure. If I'm gonna be able to bring her along with us."

Eventually we got the head of the hospital involved. I was told to send them a letter and it got denied. Ultimately, they said, "you know, we can't guarantee that it's possible when you go into labor and you show up, everyone will be allowed in, we can't guarantee that that's gonna happen." So I was like, okay, I have to figure out something else.

So I switched hospitals and this hospital is a little bit farther from my house, but still in the area. Their cesarean rate was a little over 28%. So, you know, and again, hindsight's 2020 maybe. I wish that I had had my first birth at this hospital as well. I met the providers. They were really welcoming, especially during COVID and such a weird time.

I was really thankful that they took me on as a patient. Especially being so late into my pregnancy, they said it wasn't something they typically would do, but they really accommodated me, my doula, my husband. They welcomed everyone with open arms. I think I only met maybe two of the providers before I went into labor.

I went into labor again, oddly enough, eight days early with my son.

"Why Don't You Just Schedule Another Cesarean?"

Jen Kamel: So, while you were pregnant and going through this journey, what did friends and family say about your intentions to have a VBAC?

Licia Popernack: Um, I don't know that anyone really understood, like my desire to have a VBAC. Everyone knew that I wanted to do it, but there were comments like, "well, you know, don't you just want to schedule the surgery because then you can choose the due date."

And especially with being a teacher, they're like, "okay, well it makes sense that you could just have them on this day and you could work up to this day."

And then with having other children at home, like, "oh, well then we can plan to come down." So just like logistically, it was a lot of, "okay, well why don't you just schedule it?"

I think because of so much misinformation that's out there, or just people not being informed at all. They hear VBAC and, "wait, what's that acronym mean? Oh, you are, you allowed to do that? Can, you can have a vaginal birth after you have a cesarean?"

So a lot of kind of surprise, um, "oh, what kind of risks? What could happen? What if it doesn't go well? Well then are you gonna labor and push and then have another C-section? That recovery is probably way worse than if you just scheduled it in the first place."

So again, people meaning well and kind of putting their foot in their mouths along the way, I guess.

Jen Kamel: How did that impact you, if at all, during your pregnancy? Kind of navigating and deflecting, well-intentioned comments that really miss the mark?

Licia Popernack: I feel like I really stopped engaging. I was less likely to share my plans with people. So especially like a few people from work that, "oh, well when are you gonna schedule? When's your last day?" And I would just say, "oh, my due date is blah, blah, blah." And then I kind of would move on.

So I felt like the best thing that I could do, whether people meant well or not was just kinda less, is more, "oh, this is when I'm due. Yeah, we found out this time we're gonna have a boy" and just kind of pivot the conversation.

Especially if they didn't know that I had had a C-section before. I think a lot of people just assumed, "oh, like you already had a vag. Oh, they'll fly." Then some people would be like, "oh, they'll fly right out the, the second one." And then those kind of things kind of hurt my feelings too. You're like extra sensitive when you're pregnant, but it's like, "oh, fly right out. Like, okay, I pushed for four hours."

And of course they don't know any of that information, but just from all different angles, people mean well. And it just makes me really watch what I say to anyone that's having a baby.

Jen Kamel: yeah, yeah. It's true. It's true.

Licia Popernack: "Congratulations!"

Jen Kamel: exactly You look amazing!"

Licia Popernack: yeah.

Her Second Labor: "She Said I Could Never Have a Vaginal Birth"

Jen Kamel: So can you tell us about your second labor? How did that play out?

Licia Popernack: So same thing, I went into labor eight days early in the middle of the night. We got to the hospital in the morning. This time though, when I got there, I was eight centimeters. So I was really excited. I was like, "okay, last time I was only three. This time, you know, I'm way closer to, to being in the final stage."

My water broke spontaneously, so I was like, "okay, this is great." But I still had a lot of kind of fear that I was holding onto where I knew I wanted a VBAC and I was there and I had prepared and I was going to be ready to tackle all the things. But I just, I don't know. You know, you get in your own head or you think about things people said to you, or I picture my doctor, oh, the curved tailbone, the rickets, like, what?

And then I'm like, "okay, she said I could never have a vaginal birth." And even though I was with a different doctor, those things come back up. This time baby wasn't sunnyside up, so I was like, great. But actually he was in like a transverse position, so it ended up being probably worse.

Her Decision To Get An Epidural

Licia Popernack: Yeah, I just think I had a lot more fear. The second time I felt less calm. I felt like I had more pain. I wasn't as in control even with the hypnobirthing. I was more open to some intervention. Basically I wanted to try whatever I could to not have another C-section.

So this time when they offered me the epidural, I accepted. I said, "okay, maybe this will help me relax."

I was adamant I didn't want an epidural with my first, but then I thought, "well, maybe if I had one I could have rested." So I got an epidural. I pushed, I don't, I think, you know, pushing ineffectively maybe for the four hours and it didn't pan out.

And then with this one, I feel like I probably didn't push any more effectively because I couldn't really feel what was going on with the epidural. But I did push for about two and a half hours. Generally everyone was pretty respectful of my birth preferences. Nobody really was bringing up a C-section, which I was hopeful. And I had that typed out, like, please don't mention a cesarean unless it becomes some sort of like dire situation. I had the doula there.

My husband was great, the nurses were great. And I have an immense amount of respect for doulas and for what they do. But actually for me, I felt like having the doula made my husband a little bit more hands off than he was the first time around. So like, unpopular opinion for me it ended up being like, kind of like too many cooks in the kitchen a little bit.

Vacuum, FTP, Second Cesarean, and NICU

Licia Popernack: But I was really thankful to have my doula after the surgery because what happened was when I was pushing and pushing they offered me the vacuum. So we tried that and then ultimately there were some signs of distress that started to pop up, signs of meconium.

So they said, "all right, you know, I think we should do the cesarean. If you want, you can push a little while longer." But even with the vacuum, he wasn't.

It was this arrest to descend situation where he wasn't moving to the proper station, and I just felt like everything came flooding back, that it was all kind of repeating itself.

But this time when I was on the table, I felt like it was an eternity. Like I felt like with my daughter, when I went into the surgery, it was like 10 minutes. I don't know how long it really took, but it felt like it was the blink of an eye. It was over really quickly. And with my son, it felt like an exponential amount of time.

It just was on and on and on. And then when they finally got him out, he wa he was distressed and they whisked him away quickly to the NICU because of the meconium. So my husband went with him, and then I'm just alone. And no one's really telling me what's going on. So it was really scary.

And then when they wheeled me into the recovery room, I was in there for two hours. The labor and delivery nurse that stayed with me was amazing. My doula was incredible at that point. Like I really, I really needed her. And it was great 'cause my husband wasn't there.

Processing Her Planned VBAC and Second Cesarean

Licia Popernack: And, um, I don't know, as, as more traumatic the second birth experience was, I felt way more accepting of it. And I felt like it was oddly healing in its own way.

Which sounds really weird, but with the first one, I felt like this wasn't necessary. And with the second one, it really was kind of like a reality check a little bit for me, where it's like, "okay, now I get what all those well-meaning people were saying about, well, you're okay and you have a healthy child."

What more could you want? And I did have like some guilt that I was kind of working through, like, "wow, did I make a mistake trying for a VBAC? Did I put him at risk? If I had had the C-section, he wouldn't have had meconium or maybe, you know, I'd be holding him right now." So I, it gave me a kind of a new perspective and an appreciation for things.

I feel like I bonded with him faster. I feel like I was more accepting of the hand that I was dealt, and I knew I tried my best.

So with the first C-section, I felt like it wasn't necessary, and maybe I was cheated from this experience that I had kind of dreamed of. And with the second birth, it was a complete 180 where I felt like it was very necessary.

Had I waited too long, maybe things could have ended differently. It really was kind of a sobering experience and it made me appreciate, how lucky I was.

I feel like in, in its own way, even though my VBAC wasn't successful in the end, it was really healing in its own right anyway, it still was redemptive, it still was healing. It gave me a new perspective and it made me appreciate, that I had access to a surgery that my son was okay. I was okay, everything was fine.

But yeah, it gave me a different outlook on things where I still felt cheated from the first experience. But then I felt lucky. I still was disappointed because it didn't end the way I wanted it to but I, I am grateful because I do think it, it had healed me in ways that I wasn't anticipating.

I thought for sure if I had ended with another surgery, I would've just been really disappointed. I felt like I processed and managed it a lot better than the first one. Physically, the recovery was worse, but that's, you know, you're running after like a toddler while you're healing from a c-section after laboring was not great, but mentally I was in a much better head space.

Pregnant After Two Cesareans, Now What?

Jen Kamel: So when you got pregnant the third time, what were your thoughts? What was your plan?

Licia Popernack: So I knew, my third would be our last. So I was really hopeful. I'm like, okay, third time's the charm. I really, really want this to happen. And I can't believe, I can't believe it did. Again, I'm really lucky none of my doctors really were negative about VBAC. They all, you know, for varying levels of support, but actually two of the doctors in the practice had VBACs of their own.

So mentioning that I wanted a VBAC after two [cesareans]. Nobody was like doing cartwheels and jumping up and down. And definitely we're looking at patterns and thinking, "okay, well sometimes history can repeat itself," but nobody really tried to talk me out of it. Everyone was generally supportive. I'm just really thankful that I had access to a hospital with great providers and resources, which I know some women can't even find a hospital that will allow for VBAC.

For people that were asking, or people close to me that knew that I had two prior cesareans and they knew I wanted to go for a VBAC again, most of them kept their opinions to themselves, but you could tell it was coming from a place of love, but a place of worry like, "oh, well, didn't work the first time or the second time. Like, are you sure? You know? And then with your son, he was distressed, like, are you sure you want to go down that road again?" But I'm glad, I feel like I made the right choice.

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How Her Third Labor Was Different Than The First Two

Jen Kamel: What was your third labor like, and can you identify any differences between your third labor versus your first and your second?

Licia Popernack: So my first two pregnancies were like textbook, the pregnancy part. So I had generally really easy pregnancies. I guess my biggest downfall was I'm pretty petite. I'm five one. I'm around a hundred pounds when I'm not pregnant. And I gained like 55 ish pounds with my first two pregnancies. So I know that probably didn't help, although both babies were around seven pounds, so they weren't really, you know, large.

With my third, I had a really challenging pregnancy, and I'm older, advanced maternal age, and so I know that that also kind of stacks the odds against you when you're going for a VBAC or especially with a VBAC after two.

But, um, during the pregnancy, which was really difficult, I had some health problems unrelated to the pregnancy that were going on. Because of that, or partly because of that, I didn't gain as much weight when I was pregnant. I only gained, I don't know, maybe 30 pounds. So I don't know if that made a difference.

My son ended up being a little bit smaller than the other two, so he was under seven pounds. He was like six pounds, maybe 10 ounces. So I don't know if me not having gained as much weight was part of the puzzle for that. But the labor was great. So the labor was like night and day with the other.

If everything I dreamed of for the first two I felt like was embodied and I got to experience with him. I was convinced, I thought for sure, like the other two, I'd be like, okay, I'm gonna go into labor eight days early again. With him, I went into labor three days early, so he was a little bit later, but still went into labor spontaneous, still was in the middle of the night.

We got to the hospital around 7:00 AM and I was about nine centimeters when we got there. They couldn't believe it. I didn't want to get an epidural. I felt like with my second, me and my providers kind of agreed on, "okay, well you'll get the epidural, this way, if there's an emergency situation, we don't have to put you to sleep. You can have a C-section, but you can be awake."

And this time I thought about that, but I was like, you know what? I feel like if I get the epidural for that reason, then I'm kind of like accepting somewhere in my mind that like, okay, this could end with a C-section." So I'm like, "no, I'm all in. I don't want an epidural. I basically want everybody to leave me alone."

And, and my husband was incredible. The labor and delivery nurse was unbelievable. She really knew what she was doing and she helped me get into so many different positions when I was pushing so that he could get to the right station.

I got to the hospital around 7:00 AM and he was born at 8:50. So I can't believe that. Yes, it was a really, a short-ish labor. I only pushed for like an hour and a half. I never really felt out of control. I didn't really feel afraid. I felt like everything was going well and that it was really gonna happen.

When you get to transition, then you start to get a little bit like, "okay, can I do this? I don't know if I can do this." And as soon as I said, "I'm not sure, I'm not sure if it's gonna happen. And without missing a beat, my nurse was so wonderful. She brought in a mirror and she's like, "look, you could see him. He's coming." And I'm like, what? I just, I couldn't believe it.

It was funny 'cause it was a doctor, the only doctor I never met in the practice was on, and she came in for like two seconds. She's like, how are you doing? And then she left. So then I got a little bit nervous. I'm like, "oh no. He's not really coming because if he was, she wouldn't have left. She would've stayed."

So they're like, "no, look, look like you can see he's coming. Just keep pushing. You're doing it like he's moved down. It's not arrest of descent. He's coming and he's at the right station and things are moving forward and whether you want to or not, like there's no turning back. You're gonna have this baby and you're gonna have this baby vaginally."

I'm looking in the mirror. I couldn't believe it. And then when the doctor rushed back in and then they're tying up and getting all ready and I was like, "oh my gosh, he really, okay. The doctor's not leaving again. Like he's coming." And I pushed and. Here he was.

And my husband said, the first thing that I said, which I don't remember, I like blacked out I guess. But as soon as he was born, I screamed what the, 'cause I, I couldn't. And everyone in the room was like, what? Uh, I just couldn't believe. I was like, I did it. I did it.

Then he took that picture of us immediately. I got to hold him immediately. I got to nurse him immediately and it just was everything I dreamed of. I got to shower two hours later. I didn't have a catheter. I didn't have an IV. It was unbelievable. It was one of the best days of my life for sure.

"Made Me Get Into Positions That Weren't Comfortable For Me"

Jen Kamel: So your first baby was posterior, so that means the back of their head was up against your spine, your second, what was their positioning? And then for your third baby?

Licia Popernack: My second was in kind of a transverse, not fully transverse, but not optimal position. Then when they tried the vacuum, actually it ended up like what the part of the head that they thought they were suctioning was not actually the part of the head that they were suctioning. So he really was not in a good position.

And then they did like a scan to make sure he didn't end up with like a bleed or something. So that was a whole nother story. But he was not in a great position. Worse than the sunny side up situation. And then with my last son, he was in the optimal head down position.

Jen Kamel: Which I think just shows the power. One of the things that I think is important to stress to parents and also for clinicians to remember to tell parents, is that there are so many different factors that go into how a labor plays out, and you change up just one of those factors, and you can have an entirely different experience. And as I hear your three different labors, and as I think about the impact that just the positioning of your baby could have on your delivery.

Licia Popernack: Yeah, you could do like Spinning Babies and you can try all these different things which are wonderful. But for me, I feel like part of it was just the stars aligned and again, having an incredible nurse that was really involved and made me get into positions that weren't comfortable for me.

I know a lot of books and a lot of advice is given on, oh, like your body will know what to do, your body knows what kind of position to get into. And I wanted to like squat on the floor, which maybe worked for some people, but it wasn't opening enough in my hips. So she had me climbing up on the back of the bed and like putting one leg up and trying to create some sort of imbalance between like how I was opening my pelvis.

And I feel like without her knowledge, I read those things and I took a class on like effective pushing through Mamaste, and I tried some different things. But when you're in the trenches and it's all going on, sometimes it's just flies outta your, you know, you don't remember all the things that you thought you would do, when you're calm and you're preparing and doing the reading.

So I'm so thankful to my nurse because she was incredible. And I was like, I can't get my leg up there. And she's like, "do you want this or not?" She's like, "I'll help you get your leg." I was like, "okay. Yeah. Yeah." So I was glad that she was like a warm demander. She was like, "okay, well if you want this to happen, I'm trying to help you. This is what you need to do." And, and she was great.

Did Anyone Mention Placenta Accreta?

Jen Kamel: So throughout your three pregnancies, did anyone ever ask you how many children you thought about having or intended to have?

Licia Popernack: They didn't necessarily ask me that, but it was more or less like I was told like, "okay, well you probably don't want to have more than four kids." They were assuming you're gonna have all these cesareans that we don't recommend having more than four cesareans. And I was like, okay.

Jen Kamel: And did anyone ever mention the risk of placenta accreta that can come with prior cesarean?

Licia Popernack: My doctors, I don't remember bringing that up. But in doing some of my own readings, when I had my ultrasounds done, I had them see where the baby had implanted and where the placenta was forming, because I was really hoping that it wasn't anywhere near my scar.

But I'm wondering since I was lucky enough that nothing disrupted my scar that maybe that's why it was never brought up to me.

Her VBA1C and VBA2C Advice

Jen Kamel: So what are your biggest pieces of advice for other people who want to VBAC after one or two prior Cesarean?

Licia Popernack: I think it's important to educate yourself and to find if you can, to find a provider who is supportive. I think that's the biggest key and to look up the cesarean rates for your local hospitals. They don't always publish VBAC rates, but to ask doctors how many VBAC births they have attended, what their VBAC rate was.

Asking them about have they had experience with uterine rupture or anything that is on your mind. And we all know that uterine rupture is at the forefront of risks. And when people start talking about the risks of VBAC, that's like the number one thing that comes up and for good reason.

But actually one of the doctors I asked about uterine rupture, and if he had any experience with that, he said, and he had been an OB for almost 40 years, and he said in all the time he had been practicing, he had seen uterine rupture in just two births. And actually both of them were in first time mothers. People associate ruptures, I feel like almost exclusively with prior cesareans, but unfortunately, it's something that could happen to anyone.

So that kind of put things in perspective for me too. So I think just being open with your doctors and being on some sort of level about what you want and what they're able to provide.

Jen Kamel: Looking back, is there anything you wish you knew when you were pregnant after one or two prior cesareans that you didn't know then?

Licia Popernack: I think it's important for anyone, even if you never had a cesarean, even if you are not pregnant, just anytime you're talking to a doctor, you know, doctors go into the field to help people. And I think ultimately any sort of decision a doctor is making is to benefit you.

They want you to be okay, or they want your child to be okay, and they want things to go well because, you know, if you think about things that they've likely seen, they've seen the one in 10,000 risk happen. So they've seen bad things happen.

But I think also believing in yourself and hearing other people's stories and reading books and looking at peer reviewed articles and arming yourself with information is really, really important.

Because while doctors do want to help you, they're not necessarily thinking about all the pieces of the puzzle that are working together.

What She Would Have Done Differently

Jen Kamel: If you knew then what you know now, were there any decisions you would've made differently?

Licia Popernack: I think with my first, I probably would've gone to a hospital that had a lower cesarean rate. Like I said, I would've said no to the breaking of the waters and, I would have declined probably the cesarean and pushed longer.

With my second, I don't know that I would change anything, even though it ended in a c-section. I think I would go through the same choices going through the labor and then going through with the cesarean again, was healing in its own right. I think if I had scheduled a c-section, maybe the recovery would've been easier but then I would've just been wondering, what if could I have done it?

With my third, there's really nothing that I could change. I'm thankful that I had supportive providers. But even with them being supportive, you still just, I think women really need to be on the lookout for things that are said kind of covertly to make you maybe doubt yourself or change your mind.

No one ever said that they didn't think I should try for a VBAC after two cesareans, but sometimes it was implied like, I was offered a growth scan. "Oh, well, you know, your other babies were like seven pounds. Maybe let's get you in for a growth scan at like 36 weeks and see how big baby's looking."

And it was like, "huh, you know, it sounds like a good idea." And I could see a lot of women wanting, "oh sure, that sounds great. Let's do that." But I knew in the back of my mind that growth scans that late in pregnancy aren't really reliable measures of a baby's size. And I knew that if I went through with the scan, then, even though it's not accurate, then that's in the back of my mind.

"What if my baby's 10 pounds? What am I going to do?" So I think, women just really need to be on the lookout for things like that.

I think that with other women having the opportunity to hear my story here on VBAC Facts® is to have hope and to believe. We're capable of so much. Our bodies are capable of so much and anything is possible.

You could do all the prep and the planning, and ultimately when you show up and you're in labor or you get induced or you schedule a surgery, however your baby's coming into the world. There's so many factors that are at play and things are out of our control a little bit.

But just having hope and making the decision that's right for you and right for your family, I think is the most important thing. not to be influenced by outside sources or misinformation when you're trying to make the decision that's that's right for you.

"Changed Me To Be More Accepting Of Things"

Jen Kamel: How have your births changed you?

Licia Popernack: I think my births have changed me to be more accepting of things, be more accepting of things that I can't change, that not everything will be in my control. I can be sort of type A about things, so that's really hard to realize that you can't always call all the shots, even if you do the prep work.

I think that I have more of, a little bit of a go with the flow way about me now just in going through what I went through with my first birth, my second birth, and then with my last birth.

Having such unique experiences with all three, it's kind of come full circle. I feel like you need to give yourself room and give yourself grace to, to grow and process and just do the best you can.

Advice: "But My Doctor Won't Let Me Plan a VBAC"

Jen Kamel: What's your advice to people who say, "but my doctor won't let me plan a VBAC."

Licia Popernack: To find a new doctor. I know that hospitals, different hospitals have different regulations or different plans in place and for good reasons. But I think if your doctor's telling you you're not allowed to do something that's a big red flag and not necessarily just for childbirth. I think your doctor should be helping you to make the decision that's right for you.

I don't think they should ever be telling you you're not allowed to do something unless it's something that could actively harm you or someone else. So if somebody wants to experience a VBAC, that's a safe option, a very safe option. You shouldn't be the one that has to convince your doctor that that is safe. So I would say yeah, try to find a provider that's a better fit for you.

"There's Not One Thing That's Right For Everyone"

Jen Kamel: As we wrap up, is there anything else that you'd like to share?

Licia Popernack: I think to anybody that's having a baby, whether you're choosing to have a repeat cesarean or you're a first time mom and you're having a cesarean, or you're deciding if you want to do a TOLAC or you want to do a VBAC after two or after multiple, it's just such a personal choice that it's really an intimate decision that you need to make with your support person and yourself and think about your family.

There's not a one size fits all. There's not one thing that's right for everyone. What's right for me wouldn't work for someone else. But I just want people to know that if you're like me, if you are going through a similar experience where you've had multiple cesareans for CPD or arrest to descend, that you could have the birth experience that you're looking for. You could have a successful VBAC and have a healthy child and just a great experience.

Jen Kamel: Thank you so much for sharing your story with us today, Licia.

Licia Popernack: Jen, thank you so much for having me. I think all the work that you do, sharing women's stories and sharing the facts and just moving forward and getting the correct information about VBACs and how safe they are for most women, getting all that out there, I think is so inspirational and you reach and touch so many women's lives and you give them a chance to have the birth that they're looking to have. So thank you.

Jen Kamel: Thank you. Thank you so much for everyone else who's joining us today. Until next time, I'm Jen Kamel VBAC Facts® founder. And don't you forget what we're about. Since 2007 our focus has been to provide accurate and objective information on vaginal birth after cesarean and repeat cesarean to parents, professionals, policymakers, and the court so all decisions can be informed, ethical, and just.

I'll see you again in two weeks.

Until then, take care. Bye.